HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: A I I r bvx- Permit Number:
t e �2
BuildingApplication
Planning and Development Services
Building and Code Regulation Division
1300 Virginia Avenue, Fort Pierce FL 34992
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential xxxxxxxx
PERMIT TYPE:
1 PROPOSED IMPROVEMENT LOCATION:
Address: /0 isC- S. DC e4 H ff, 2,90
Property Tax ID #: Y -r/I - Xa / ` O / 6 I - O 00 - 9 Lot No.
Site Plan Name:
Project Name:
DETAILED DESCRIPTION OF WORK:
Block No.
n Lill, ce Yht,ir, Ire-IrrT, t _
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit -check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters -Windows/Doors
v/Electric _ Plumbing _ Sprinklers — Generator —Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ .7ri f.rJ ov Utilities: _Sewer _Septic Building Height:
OWNERAESSEE:
CONTRACTOR:
Name 6^Let Ks Leg 4l"424w1-._Ic,
Name:JohnLaw
Address: (� 08 )IT —Lc j'r_/�ac L�
company;Law's Electrical Service Inc.
Address:5158 NW Primm St
City: Pt St Lucie State: FI
Zip Code:34983 Fax:
Phone No 772 370 4357
E-Mailiohnlaw5158@aol.com
r
City: G— ( ha�� l�r �/t Stater' �i
Zip Code: c! C"7 G;z- Fax:
Phone No. 7'J2- 9%15— R272,&
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
State or County License EC 13006370 29432
if value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
if value of HVAC is $7,500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW I
Name•--- • - — -
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: — Not Applicable
Name:
Address:
City:
Zip; Phone:
ORMATION:
MORTGAGE COMPANY: — Not Applicable
Name:
Address:
City: State:
Zip: Phone;
BONDING COMPANY: —Not
Name:
Address:
City:
Zip: Phone:
__� ,-a..u�tinn or indir�tad
OWNER/ CONTRACTOR AFFIOVII : Application is nereoy mace co uowrii a p«, — �.- ---• •--••- - --
I certify that no work or installation has commenced prior to the issuance of a permit.
St Lacie County makes no represent tion that is granting a permit will authorize the permit holder to build the subject structure
structure. Please consult with youCr Home Owners Association Association
yourdeeddeed for any restrictits ons wyhich�may apply. such
in consideration of the granting of this requested permit, I do hereby agree that I will, in all respects, perform the work
in accordance with the approved plans, the Florida Building Codes and St. Lucie County Amendments.
The following building permit applications are exempt from undergoing a full concurrency review: roam additions,
accessory structures, swimming pools, fences, walls, signs, screen rooms and accessory uses to another non-resfdential use
WARNING TO OWNER: Your failure to Record a Notice of Commencement may result in your paying tarice for
improvements to your property. A Notice of Commencement must be recorded and posted on the jobsite
before the first inspection. if you intend to obtain financing, consult with lender or an attorney before
as Agent
STATE OF FLORIDA
COUNTY OF
The forgoing instrum t was acknowledged before me
this j (- day of c 6 20 _AA^by
Name of person milking statement
Personally Known OR Produced Identification
Type of identification
Produced_
(Signature of Notary Public- State o � Sri
IRACHEL
Commission No.'~s '` r _?,_J MY COMM1SSi
REVIEWS FRONT I
I COUNTER REEVIIEW I S REVIEWOR
Rev. 8/2/17
Signature
STATE OF FLORIDA
COUNTY OF
The forgoing Instrument was acknowledged before me
this Ifday of Fw_ Qe
Name of person making statement
Personally Known OR Produced identification
Type of Identification
Produced
Notary Public- state of
DAVIS I
RACHEL M
('i. 'i•p MY COMMISSION
PLANS j VEGETATIONrp
REVIEW REVIEW I N REVIEW